Travis Edward Perry, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

DS039537 Issued in PA

Practice address

502 Church Street
Moosic, PA 18507

Phone

(570) 344-3500

Fax

(570) 344-9442

NPI assigned

Jun 26, 2013

Reactivated

Jan 17, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greater Philadelphia Health Action Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1205140902
  Medicare reassignment NPD
• Greater Philadelphia Health Action Inc.

  • Dental Clinic/Center
  • Philadelphia, PA
  • NPI 1710040878
  NPD
• Greater Philadelphia Health Action, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1275151607
  NPD
• Moosic Dental Group Inc

  • Dentist
  • Moosic, PA
  • NPI 1316044431
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1104266824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST ST",
            "address_2": "FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 CHURCH STREET",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "18507",
            "telephone_number": "570-344-3500",
            "fax_number": "570-344-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "TRAVIS",
        "middle_name": "EDWARD",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "deactivation_date": "2019-10-23",
        "reactivation_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zuhri Outland, LSW
• Amber Michele Parker, PMHNP-BC
• Thomas Anthony Patts, PA-C
• Samantha Lynn Pavolko
• Penn Neurology and Psychiatry Associates, PC
• Sarah Pilosi
• Rachel Platko, LPC
• James Oliver Poepperling, DPT, L.AC.
• Lynn Marie Pons, LCSW
• Brian Porcelli, LSW

• Dentist in Moosic, PA
• Providers in Moosic, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.